Elective direct current cardioversion of atrial fibrillation - silent brain infarction and health related quality of life.

Introduction: Atrial fibrillation (AF) increases the risk for stroke, dementia and impaired health related quality of life (HRQL). Elective direct current cardioversion (ECV) is often used to restore sinus rhythm, but is associated with thromboembolism. While larger strokes usually produce symptoms, subclinical ones may go unrecognized and may cause cognitive and functional decline over time. In the current study, we sought to evaluate the effects of ECV on silent brain infarctions and HRQL in patients with AF.

Methods: Patients with AF (n=46) underwent brain magnetic resonance imaging (MRI) and HRQL assessment using the EuroQL-5D5L questionnaire before and after ECV. Implantable loop recorders (ILR) were used to observe the rate of early AF recurrences within the first thirty days. All patients were treated with anticoagulants according to guidelines. The primary endpoint was silent brain infarction assessed by brain MRI within the first two weeks after ECV. Secondary endpoints were the change in HRQL and its association with AF recurrence at follow-up and by ILR recordings.

Results: New silent brain infarction after ECV was detected in one patient. At follow-up visit after 19.1 days AF recurrence was detected by 12-lead ECG in 13 patients (28.3 %), whereas 27 patients (58.7 %) had AF recurrence recorded by ILR within the first thirty days after ECV. European Heart Rhythm Association (EHRA) symptom score and the EuroQL-5d5L score were improved after ECV.

Conclusion: Silent brain infarctions may occur after ECV despite anticoagulation treatment. Early AF recurrence is frequent. ECV positively affects HRQL mainly in those patients with sustained sinus rhythm at follow-up.